The medial collateral ligament (MCL tear) is an injury to the knee ligament, a common injury among those who play contact sports and martial arts. Ligaments are elastic fiber bands which hold the bones of the human body together, providing the necessary stability and strength to the joints.
The MCL is a ligament that connects the top of the shinbone, medically known as the tibia and the bottom of the thighbone, medically known as the femur. It is located on the inner side of the knee. Ligaments can either get stretched beyond their normal range, or they can even get torn due to an injury.
MCL tears usually result due to a direct blow to the knee, as well as, blows to the outer side of the knee. In these cases, the affected knee will bend too far in a direction that it should not bend, or the knee can get overextended.
What Causes MCL Tear?
Those who play contact sports such as hockey, football, soccer, etc., as well as those in martial arts, have a higher risk of ending up with an MCL tear. However, anyone can end up with an MCL tear.
You can end up with an MCL tear even if you fall, especially if the legs get splayed out at an odd angle. MCL tears usually result from a direct blow to the knee while playing any of these contact sports, which will stretch out more than it should the MCL ligament on the inner side of the knee.
The MCL ligament can even get torn in such an injury. Another mechanism how MCL ligaments can get damaged is in cases when the knee suddenly is pushed to the side, as well as when the knee is twisted or bent out too far.
Grades of MCL Tear
There are three grades of MCL tears (grade 1, grade 2, grade 3) based on the severity of the injury and the extension of the ligament damage.
Grade 1 MCL tear is characterized only by an overstretching of the medial collateral ligament, but the ligament is not torn. This is the least severe MCL tear injury, normally with a short recovery time and good outlook and only less than 10 % of the ligament fibers have been damaged.
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Grade 2 MCL tear is a partial damage to this ligament, where the ligament is only partially torn. Compared to grade 1 MCL tear, this type of injury is more severe, with a longer recovery period of course. Significant knee instability is associated with this type of MCL tear where 10 to 90 % of the ligament fibers have been damaged.
Grade 3 MCL tear is the most severe type of MCL injury characterized by a complete tear of the ligament. 100 % of the ligament fibers have been damaged. Joint instability is a common problem among this type of injury, which normally has a prolonged recovery period, sometimes requiring even surgical treatment
What Does Torn MCL Feel Like?
Any knee injury will hurt, including an MCL overstretching or tear.
How it will feel will depend on the severity of the ligament fiber damage. In most cases, and especially in severe injuries of the MCL when the ligament is completely torn, the person will know exactly when the injury occurred.
An MCL injury is often accompanied by a popping sound. The knee may lurch to the side as well. In grade 2 and especially in grade 3 MCL tears, there is also knee instability, making it impossible to land on the affected leg. Walking is impossible and too painful as well.
In mild injuries, a person will describe an MCL injury as tenderness or soreness of the injured knee, rather than real pain. However, the symptoms tend to get worse within a couple of hours when pain, bruising, and swelling start to become noticeable.
In certain cases, the knee can get locked or catch when walking which makes it obvious that a serious knee injury just occurred.
Common Symptoms of MCL Tear
The symptoms of MCL tear will depend on the severity of the injury. Grade 1 MCL tear has fewer signs and symptoms present, which are only mild, while grade 2 MCL tear has moderate signs and symptoms. Grade 3 MCL tear has severe signs and symptoms and even knee instability is present.
Characteristic symptoms of an MCL tear are:
- Pain of the injured knee localized on the inner side of the knee,
- Tenderness on the inner side of the knee,
- Swelling of the knee,
- Bruising of the knee,
- A popping sound upon injury,
- Knee stiffness,
- Locking of the knee,
- Catching of the knee,
- Knee instability,
- Inability to put any pressure on the affected leg,
- Inability to walk, etc
Medial Collateral Ligament Tear – Diagnosis
First of all, your doctor will want to know how you injured your knee and what kind of symptoms you have been having since the injury.
A knee examination is necessary when diagnosing an MCL tear. During the physical examination of the knee, your doctor will probably bend the knee and even put pressure on the outer side of the knee, in order to diagnose an MCL injury.
Your doctor will probably tell you to relax the leg muscles as much as possible during the physical examination, which will make it a lot easier to test the knee ligament stability. In cases of a knee ligament injury, a certain level of pain and tenderness on the knee during the physical examination is possible.
In cases of a knee injury diagnosis, your doctor will probably order some imaging tests, such as an X-ray of the affected knee. Knee X-ray will help your doctor determine if there are any bone damages present. This is especially important when making a differential diagnosis with other knee problems, helping your doctor to rule out other knee conditions.
MRI scan is another imaging test that your doctor might order while diagnosing a knee problem. MRI is an imaging test which uses magnets and radio waves to produce an image of the certain part of the body that is being examined.
MRI machines usually make loud noises so there is nothing for you to be scared. With the help of an MRI scan of the affected knee, your doctor will be able to determine any damage to the knee muscles or knee ligaments.
MCL tear treatment depends greatly on the severity of the injury. Normally grade 1 MCL tear is easier to treat, compared to grade 2 and especially grade 3 MCL tear.
In most cases, MCL injury can recover on its own, after a couple of weeks. However, certain treatment measures are necessary in order to ease the pain, to stabilize the knee and to speed up the recovery.
PRICE which means protect, rest, ice, compression, and elevation, is one of the immediate measures that one should take after a knee injury, regardless of its nature. PRICE is an important part of the treatment even for MCL injuries of the knee.
Protecting the injured knee is very important immediately after the injury as it will prevent any further damage to the knee structures. For example, if the injured knee is not protected correctly after the injury, an overstretched medial collateral ligament can be torn, or a partially torn medial collateral ligament can get completely torn. A grade 1 injury can easily become a grade 2 or a grade 3 injury with no protection.
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Rest is also very important part of the treatment. After a ligament injury, resting the affected knee will give enough time for the knee structures to completely heal. If you don’t rest then normally the damage can get more severe, but the recovery period will be prolonged as well.
Ice packs are recommended too immediately after an injury. Make sure to use ice packs for no more than 10 to 15 minutes every 2 hours in order to reduce the pain, discomfort, and swelling associated with an MCL injury. If ice packs are not used as recommended you can end up with an ice burn, so be careful.
Compression of the affected knee with compression bandaging is another part of the immediate treatment which will help prevent the swelling of the knee and even reduce it. However, you need to make sure not to compress the affected area too tight.
Elevation of the affected knee above the heart level will promote blood circulation which is normally very important during the recovery period after a knee injury. It will also help reduce the swelling of the injured knee as well.
NSAIDs (Nonsteroidal anti-inflammatory drugs) like ibuprofen, aspirin, etc., are recommended in order to ease the pain and discomfort after an MCL tear. In cases of severe damage prescribed painkillers might be necessary.
In rare cases, surgical treatment of an MCL tear is necessary. This is more likely to occur in grade 3 MCL injuries when the ligament is completely torn in a way that it can’t get repaired on its own.
Surgical treatment is also more likely to be needed in cases when an MCL tear is accompanied by the damage to other knee ligaments or other knee structures, which makes this kind of injury a complex one.
With the help of arthroscopy, the surgeon will first thoroughly examine the injured knee, followed by an MCL ligament repair with stitches, metal screws, bone staples, suture anchors, etc.
Rehab should be part of an MCL tear injury. As you recover from this type of injury, you will normally want to regain the knee strength and flexibility of the knee joint.
For this purpose, certain strengthening and stretching exercises will help you recover completely. A physical therapist will recommend and teach you how to perform these exercises correctly in order to fully recover as soon as possible.
A full rehabilitation is very important for athletes. For this purpose rehabilitation with various strengthening and stretching exercises is a must. Your physical therapist will give you the green light to start with these exercises, as soon as it is comfortable for you.
The most important thing is to wait until it is safe for you to start exercising again as getting back too soon on the track can lead to a further damage of the ligament and worsening of the situation. This will prolong the recovery period too, something you don’t want for sure.
When performing stretching and strengthening exercises during a recovery after an MCL tear it is very important to listen to your body as well, and not to overdo it. If you feel pain while exercising, you should stop and rest. You can always try again tomorrow.
Quad muscle exercises are the recommended exercises for you to begin with. While keeping your legs stretched out, start contacting the muscles above the knees. If it feels comfortable for you, start raising the affected leg a few inches from the floor.
During rehab, as you progress with your stretching and strengthening exercises, you can start doing squats, lunges, etc.
Knee Braces for MCL Tear
Using the best knee braces are an important part of an MCL tear treatment.
These knee braces will provide the necessary support and stability for the affected knee during the recovery period, preventing the knee from any lateral movement which can damage the MCL ligament even more.
Usually hinged knee braces are the best one for this purpose.
How Long Does it Take to Recover from MCL Tear?
The outlook of an MCL tear is usually good, regardless of the severity of the injury or if surgical treatment is needed. However, the recovery time will greatly vary from the grade of the injury.
The recovery period will take only a couple of days in minor grade 1 MCL tears and usually less than 2 weeks. Most athletes will get back to sports within one week after the injury.
The recovery period for grade 2 MCL tears will take up to 4 weeks. However, the recovery period is something totally personal, varying significantly from other circumstances.
The recovery period for grade 3 MCL tears will take at least 8 weeks. Often the recovery will take even more, especially if other knee structures have been damaged.
In cases when an MCL injury involved surgical treatment, the recovery period usually takes 2 to 3 months. During this period you should rest in order to prevent any further damage to the ligament and other knee structures which can lead to long – term complications and even prevent you from playing sports in the future.
How to Prevent MCL Tear?
First of all, you need to listen to the instructions of your doctor and your physical therapist while recovering from an MCL injury. If you follow their advice and tips you can prevent further damage of the knee joint, as well as, any damage of the MCL in the future. Avoid playing sports or any other vigorous activity until you have fully recovered.
In order to prevent MCL tears from occurring you should be very careful when playing contact sports. Avoid any direct contact and especially direct blows to the knees while playing with your teammates.
Avoid any fast turning, twisting of the knees or other sudden movements which will put extra pressure on your knees, often leading to various knee injuries, including MCL tears.
Stretching and strengthening exercises are also a great way to prevent MCL tear injuries. If you have strong and flexible leg muscles, you will have less possibility to end up with an injury. A proper warming up before playing any kind of sports is also a must.